Practice Tip of the Week: Facing Facts About Racial Bias in Health Care
Tuesday, June 4, 2019
Posted by: Roy Muyinza
By: Ellen Martin, PhD, RN, CPHQ
Director of Practice, Texas Nurses Association
Two weeks ago, Sen. Kamala Harris reintroduced the Maternal Care Access and Reducing Emergencies (CARE) Act, which seeks to tackle the nation's crisis of maternal mortality among black women by addressing racial discrimination in the health care industry. The CARE Act establishes Implicit Bias Training Grants for medical, nursing, and health professional training programs “to ensure that women have access to comprehensive, culturally competent care.”
After this announcement, a few nurses responded with outrage believing that they were personally being accused of racism and insisting that “they don’t see color in the bed.” Online comments asked nurses to band together in protest to these negative comments about nursing.
However, nurses need to recognize that all of us hold implicit biases and that “not seeing color,” while socially admirable, can also have a detrimental effect on care. At Texas Nurses Association, our Maternal Mortality and Morbidity task force has recognized the disparity faced by black women, and we challenge nurses to step up to address these issues in the workplace.
Recognizing implicit bias
Implicit bias is “any unconsciously-held set of associations about a social group.” Also known as stereotyping, these unconscious attitudes result in biased judgement or behavior. Implicit bias has been researched in classrooms, courtrooms and in health care.
To resist acknowledging that implicit bias exists is to be part of the problem.
Decades of research in cognitive and social psychology reveals that these biases:
- Are automatic and generated without conscious effort.
- Are held by people who truly believe that they do not judge others based on social categories, but have been unconsciously influenced by the implicitly biased stereotypes in society.
- Affect how we process information so that it is consistent with widely held social stereotypes about minorities, women, etc.
- Guide our perceptions which shapes our interactions, producing “self-fulfilling prophecies” (our beliefs about a situation influences the interaction so that it meets our expectations).
However, to state that nurses have implicit bias is not the same as accusing of them of racism or racist actions. And implicit biases can be identified and addressed.
To tackle this problem. The National Women’s Law Center urges us to “Listen to the Data.”
Why seeing color matters
FACT: A Centers for Disease Control and Prevention study published earlier this month, using data from 2011 to 2015, found that black women had the highest rate of pregnancy-related deaths. While deaths for white women is 13 per 100,000 live births, the ratio jumps to 42.8 for black women.
FACT: It has been over 15 years since the Institute of Medicine published “Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care which reads in part:
“The study committee was struck by what it found. Even among the better-controlled studies, the vast majority of published research indicates that minorities are less likely than whites to receive needed services, including clinically necessary procedures, even after correcting for access-related factors, such as insurance status.”
When nurses insist that they “don’t see color” and report that “treat everyone the same,” are they effectively ignoring well-known risk factors for complications? For example, when black women are at four times higher risk, shouldn’t they be prioritized for closer monitoring and not treated “the same”?
Nurses are ethically bound to explore this important issue. We must ask ourselves and each other how significant disparities can exist when we dedicate ourselves to providing the highest quality care to all patients. We all have implicit biases. We owe it to our patients and ourselves to become aware of our biases and how it affects our nursing practice.
Resources to learn more: